April 23, 2021

Risky Business

Risky Business

Into-pocket expense

Two insurance agents went rogue after they collected premiums from business owners and then pocketed the money for their personal use. After complaints were received from policyholders, the insurance company decided to look into the case. Upon investigating they found that premiums were never sent to the insurer and the policyholders...


Half a roof

A sportswear storeowner found a part of the store roof missing when he opened for the day. Strong winds decided to take a part of the roof and many other things in the same city. Fortunately, the owner had insured the store and the insurance company is investigating.


A leisurely claim

A non-profit organisation was impacted by a hurricane when its building was damaged and waterlogged for weeks. The insurance company covering the organisation’s building decided to keep quiet for more than 30 days in spite of a loss adjustor’s report of proof of loss. The organisation stakeholders in turn, decided...


A cream worth millions

A businessman decided to double his earnings by indulging in a little insurance fraud. He arranged for hospital networks to reimburse claims for expensive, specially formulated pain cream. This scheme went on until a healthcare provider had to cut back its offerings and request more funding from the government. Sadly,...


Hard-hitting tree

A couple who lived in their house for the last 30 years thought they were covered for all kinds of losses when they took their homeowners insurance. Unfortunately their most valuable asset was hit by a sudden windstorm and three large trees landed on the house. The couple contacted the...


In the name of beauty

A doctor billed insurance companies in the names of dozens of surgeries while performing cosmetic procedures for his patients. He billed hernia surgeries for tummy tucks, deviated septum fixings for rhinoplasty and many others. The insurance company suspected fraud and decided to investigate. Sound familiar?


Double Trouble

An insured and her daughter claimed disability injuries from playing football, falling from a ladder and snake bite. The duo claimed at different times with their insurer, citing the same claims. The insurance team investigated both sets of similar claims and found that they had not been admitted or treated...


Collision course

A woman struck a railing while driving on the highway, but was uninsured at the time. She went home, applied for a motor insurance policy but did not report the accident. Three weeks later she filed a claim with her insurer for another similar collision with a guard rail. Unaware...


Caught by the metadata

An insured reported a claim to his homeowner’s insurance company indicating roof damage from a storm. He submitted photos as evidence of the purported damage. When the insurers checked the metadata of the photos they were found to be years older than the policy and the insured’s ownership of the...


Street racer

An insured decided to race on the street and was rammed on the side which caused him to lose control and collide with a building resulting in causing damage to two other vehicles. However he gave a different story to his insurance company and was paid for his claim. However,...

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